Lange P H, Lightner D J, Medini E, Reddy P K, Vessella R L
Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis.
J Urol. 1990 Oct;144(4):927-32; discussion 932-3. doi: 10.1016/s0022-5347(17)39624-6.
We analyzed the effects of pelvic radiation therapy given to patients who had an elevated prostate specific antigen level after radical prostatectomy. Among men who previously received adjuvant radiation therapy and had appropriately stored serum 15 had elevated prostate specific antigen levels after radical prostatectomy but before radiation therapy. After radiation therapy the prostate specific antigen level decreased by more than 50% in 80% and to female levels in 53% of the patients. We also prospectively treated 29 men who had increasing levels of prostate specific antigen 9 to 95 months after radical prostatectomy but who were otherwise without evidence of disease by the usual criteria. However, 19 of the patients had local disease as evidenced by random needle biopsy of the urethrovesical anastomosis. Complications of radiation therapy were minimal and maximal prostate specific antigen decrease occurred by 6 months after treatment. In 82% of the patients prostate specific antigen levels decreased by more than 50% and in 43% they decreased to female levels. Female levels were achieved after radiation therapy given many years postoperatively even in stage D1 cancer patients but some of the patients subsequently had increasing prostate specific antigen levels. These data suggest that local-regional disease may be the only site of disease persistence after radical prostatectomy in some of the patients who subsequently have distant metastasis. We conclude that radiation therapy after radical prostatectomy can cause elevated prostate specific antigen to decrease to undetectable levels in many patients but the durability and ultimate therapeutic value of this effect are unknown.
我们分析了盆腔放射治疗对根治性前列腺切除术后前列腺特异性抗原水平升高患者的影响。在先前接受辅助放疗且血清保存得当的男性中，有15例在根治性前列腺切除术后但在放疗前前列腺特异性抗原水平升高。放疗后，80%的患者前列腺特异性抗原水平下降超过50%，53%的患者降至女性水平。我们还前瞻性地治疗了29例在根治性前列腺切除术后9至95个月前列腺特异性抗原水平不断升高但按常规标准无其他疾病证据的男性。然而，经尿道膀胱吻合术随机穿刺活检显示，其中19例患者存在局部病变。放疗并发症极少，治疗后6个月前列腺特异性抗原下降幅度最大。82%的患者前列腺特异性抗原水平下降超过50%，43%的患者降至女性水平。即使是D1期癌症患者，术后多年进行放疗后也能达到女性水平，但部分患者随后前列腺特异性抗原水平又升高。这些数据表明，在一些随后发生远处转移的患者中，局部区域病变可能是根治性前列腺切除术后疾病持续存在的唯一部位。我们得出结论，根治性前列腺切除术后放疗可使许多患者的前列腺特异性抗原升高水平降至检测不到，但这种效果的持久性和最终治疗价值尚不清楚。
